Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children.

BACKGROUND: Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS: This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION: We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION: The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).

Tenofovir-induced renal and bone toxicity: report of two cases and literature review.

Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Case 1 presented with metabolic ileum and diffuse bone pain while case 2 presented with bilateral coxo-femoral pain after a fall from standing height. Both cases had similar laboratory tests: hyperchloremic metabolic acidosis, hypophosphatemia, hypokalemia, hypouricemia and elevated plasma creatinine. In urinary exams, there was evidence of renal loss of electrolytes, justifying the serum alterations, in addition to glucosuria and proteinuria. The bone pain investigation identified bone fractures and reduced bone mineral density, together with increased levels of parathyroid hormone, alkaline phosphatase and vitamin D deficiency. These two cases illustrate the spectrum of adverse renal and bone effects associated with TDF use. TDF was discontinued and treatment was focused on correcting the electrolyte disturbances and acidosis, in addition to controlling the bone disease through vitamin D and calcium supplementation. The renal changes found in both cases characterized the Fanconi's syndrome, and occurred due to TDF toxicity to proximal tubule cells mitochondria. Bone toxicity occurred due to direct interference of TDF in bone homeostasis, in addition to vitamin D deficiency and phosphaturia resulting from tubulopathy. During the follow-up, both cases evolved with chronic kidney disease and in one of them, the Fanconi's syndrome did not revert. We emphasize the need to monitor markers of bone metabolism and glomerular and tubular functions in patients using TDF.

Tenofovir-induced renal and bone toxicity: report of two cases and literature review

ABSTRACT Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Case 1 presented with metabolic ileum and diffuse bone pain while case 2 presented with bilateral coxo-femoral pain after a fall from standing height. Both cases had similar laboratory tests: hyperchloremic metabolic acidosis, hypophosphatemia, hypokalemia, hypouricemia and elevated plasma creatinine. In urinary exams, there was evidence of renal loss of electrolytes, justifying the serum alterations, in addition to glucosuria and proteinuria. The bone pain investigation identified bone fractures and reduced bone mineral density, together with increased levels of parathyroid hormone, alkaline phosphatase and vitamin D deficiency. These two cases illustrate the spectrum of adverse renal and bone effects associated with TDF use. TDF was discontinued and treatment was focused on correcting the electrolyte disturbances and acidosis, in addition to controlling the bone disease through vitamin D and calcium supplementation. The renal changes found in both cases characterized the Fanconi's syndrome, and occurred due to TDF toxicity to proximal tubule cells mitochondria. Bone toxicity occurred due to direct interference of TDF in bone homeostasis, in addition to vitamin D deficiency and phosphaturia resulting from tubulopathy. During the follow-up, both cases evolved with chronic kidney disease and in one of them, the Fanconi's syndrome did not revert. We emphasize the need to monitor markers of bone metabolism and glomerular and tubular functions in patients using TDF.

Metáforas de um vírus: reflexões sobre a subjetivação pandêmica / Metáforas de un virus: reflexiones sobre la subjetivación pandémica / Metaphors of a virus: reflections on the pandemic subjectivation

Resumo O presente artigo visa explorar diferentes metáforas acionadas na primeira fase da pandemia do novo coronavírus no Brasil, inspirado na obra de Susan Sontag, A doença como metáfora. As metáforas são ferramentas centrais nos processos de subjetivação da pandemia, do vírus que a causa e da doença que ela materializa. O material empírico que sustenta nossas reflexões vem de encontros semanais de um grupo terapêutico que passamos a conduzir on-line com as medidas de isolamento social no país, e de observação participante nas redes sociais da internet. Com base nisso, pensamos em quatro chaves de metáforas: o (in)visível, o mascarado, o divino e o isolado. A partir dessas categorias, é possível refletir sobre questões como sofrimento ético-político, resistência subjetiva, luto, negação, melancolia e megalomania, presentes nos modos de subjetivação da pandemia.

Resumen Este artículo tiene como objetivo explorar diferentes metáforas desencadenadas en la primera fase de la nueva pandemia de Coronavirus en Brasil, inspirado en el trabajo de Susan Sontag, "La enfermedad como metáfora". Las metáforas son herramientas centrales en los procesos de subjetivación de la pandemia, el virus que la causa y la enfermedad que le materializa. El material empírico que sustenta nuestras reflexiones proviene de reuniones semanales de un grupo terapéutico que comenzamos a realizar en línea con las medidas de aislamiento social en el país, y de la observación participante en las redes sociales de internet. Basado en esto, pensamos en cuatro claves metáforas: lo (no) visible, lo enmascarado, lo divino y lo aislado. A partir de estas categorías, es posible reflexionar sobre cuestiones como el sufrimiento ético-político, la resistencia subjetiva, el luto, la negación, la melancolía y la megalomanía, presentes en los modos de subjetivación de la pandemia.

Abstract This article aims to explore different metaphors triggered in the first phase of the pandemic of the new coronavirus in Brazil, inspired by Susan Sontag's work, "Illness as metaphor". Metaphors are central tools in the processes of subjectification of the pandemic, the virus that causes it and the disease that it materializes. The empirical material that supports our reflections comes from weekly meetings of a therapeutic group that we started to conduct online due to the measures of social isolation in the country, and from participant observation in the internet social media. Based on this, we propose four metaphor keys: the (in)visible, the masked, the divine and the isolated. From these categories, it is possible to reflect on issues present in the pandemic's subjectivation modes such as ethical-political suffering, subjective resistance, mourning, denial, melancholy, and megalomania.